Prescription opioid abuse is the fastest growing form of drug abuse. Accidental overdose with prescription opioids is the fastest growing cause of accidental death, exceeding motor vehicle accidents in 8 states. These trends run parallel to increases in use of chronic opioid therapy (COT) for chronic non-cancer pain (CNCP), now estimated at 10 million recipients or 3% of the US population. Exposure to prescription opioids increases risk for abuse and overdose in a dose and duration-dependent manner. It is not known if COT beyond 4 months actually improves pain, mood or function. Exposure to prescription opioids increases risk for abuse and overdose in a dose and duration-dependent manner. It is possible that decreasing opioid dose may reduce these risks without significant worsening of pain, mood, and function. However, no protocol for taper of COT among patients treated for CNCP has been tested. Research Goals: The proposed research will develop, demonstrate the feasibility of, and pilot test in an RCT a prescription opioid taper support intervention. This intervention aims to prevent opioid misuse and adverse events among patients receiving COT for CNCP without evidence of current substance abuse. The project will yield information essential to planning a future, larger-scale RCT designed to evaluate the efficacy of the intervention in preventing prescription opioid abuse, misuse, overdose and other adverse events among patients receiving COT for CNCP, and to evaluate the effects of the intervention on opioid use, pain, pain- related activity interference, and mood. Specific Aim 1: To develop and manualize a 22-week prescription opioid taper support intervention administered by a nurse care manager with supervision and consultation by a pain medicine/psychiatry physician and pain psychologist. This intervention will include four components: a) an engagement video and motivational interviewing intervention; b) an individualized, flexible, opioid taper; c) pain self-management training; and d) an individual psychopharmacology consultation and plan. Specific Aim 2: To demonstrate that it is feasible to recruit and retain patients receiving COT for CNCP in an RCT of an opioid taper support intervention compared to usual opioid prescribing care. Specific Aim 3: To obtain pilot data concerning the efficacy of this prescription opioid taper support intervention in: a) attaining sustained opioid dose reduction among patients receiving COT for CNCP, b) reducing opioid misuse and opioid adverse effects; and c) improving patient pain, pain-related activity interference, and mood. Impact: The proposed pilot trial will help determine the feasibility of a larger randomized trial to evaluate te efficacy of a supported prescription opioid taper intervention in reducing opioid misuse, abuse and overdose. It will also suggest whether these goals can be achieved without significant worsening of pain, mood and activity. PUBLIC HEALTH RELEVANCE: Prescription opioid abuse is the fastest growing form of drug abuse. Accidental overdose with prescription opioids is the fastest growing cause of accidental death, exceeding motor vehicle accidents in 8 states. This research will develop, demonstrate feasibility, and obtain preliminary estimates of efficacy of a supported prescription opioid taper intervention as a secondary prevention strategy for opioid abuse and misuse among patients receiving chronic opioid therapy for chronic non-cancer pain in a specialty pain clinic.